Modified Spreader Flap Tension Suture Technique for Internal Nasal Valve Reconstruction: A 580-Patient Cohort Study

Introduction: The internal nasal valve (INV) is a key determinant of nasal airflow and is dependent on middle vault integrity. While spreader grafts remain the gold standard for reconstruction, the spreader flap offers a tissue-preserving alternative. Objectives & Hypotheses: This study evaluates outcomes of a modified spreader flap tension suture technique with composite flap elevation in 580 patients, with the hypothesis that this approach yields favourable functional improvements. Study Design: Retrospective cohort study. Methods: Patients who underwent the described procedure were retrospectively identified. Inclusion required a dorsal hump reduction of >3 mm in all cases. Patients were stratified into three groups according to clinical presentation: those undergoing dorsal refinement alone, those with concurrent septal deviation or turbinate hypertrophy, and those with primary INV insufficiency. Prior dorsal rhinoplasty or significant septal deviation were exclusion criteria. Pre- and postoperative (6 months) Peak Nasal Inspiratory Flow (PNIF) measurements and Visual Analog Scale (VAS) scores were compared to evaluate objective and subjective functional improvement, respectively. Results: The dorsal refinement group (n=362) demonstrated stable functional outcomes, with a mean VAS improvement of 2 points. The septal deviation/turbinate hypertrophy group (n=158) had a mean PNIF increase of 27 L/min and a 3.5-point VAS improvement, while the INV insufficiency group (n=60) showed greater gains (PNIF +35 L/min; VAS +5 points). Conclusions: The modified spreader flap is an effective, cartilage-preserving technique for INV reconstruction, yielding consistent functional and aesthetic outcomes. Further controlled studies are required to assess long-term results.